Accuracy in hip surgery: assessment, consequence and solution
File(s)
Author(s)
Davda, Kinner
Type
Thesis
Abstract
Hip arthroplasty is the most common and successful surgical treatment for the management of
hip osteoarthrosis. However, complications arising from technical error in analysing the native
hip, aswell as the position of the hip prosthesis can result in a suboptimal outcome for the patient.
This thesis principally examines acetabular component orientation, investigating the use of
technology in this critical aspect of hip arthroplasty surgery.
In the first study, navigation technology is used to assess the performance of a current cohort of
training and senior orthopaedic surgeons in a simulated surgical setting. A wide range of error
in orientating an acetabular cup orientation to a target position is demonstrated. The second
study seeks to establish a novel method of delineating the femoral neck axis in 3D using a
sample of normal hip CT scans. Using such a proximal femoral frame of reference allows a
standardised approach to assessing normal and abnormal hip morphology. The articular margin
of the femoral head is shown to have a wave like pattern that consists of an anterior and
posterior facet. The third study compares 2D and 3D measurements of inclination and version
of acetabular components, finding a critical difference between the two in version
measurements and that 3D measurements are more reliable. The thesis continues by examining
the current methodology of analysing the concentration of cobalt and chromium metal ions in
the joint fluid from a cohort of symptomatic patients with a metal on metal hip arthroplasty. A
more robust laboratory method of processing fluid samples using a digestive oxidative method
is presented. The relationship between concentrations of metal ion levels in joint fluid and
several clinical parameters is investigated with no clear association shown, suggesting joint
fluid in itself cannot be used as a marker for a failing metal on metal hip. The thesis concludes
by comparing navigation technology to conventional ‘freehand’ method in orientating an
acetabular component in a group of patients undergoing metal on metal hip resurfacing. The
results suggest that navigation technology may substantially improve surgeon error in this task.
Technology and three dimensional imaging can play a vital role in improving the accuracy of
orientating an acetabular component in hip surgery. It can be employed in the pre-operative
stages to assess trainee performance, intra-operatively to reduce surgical error and post
operatively to investigate surgeon accuracy on CT imaging.
hip osteoarthrosis. However, complications arising from technical error in analysing the native
hip, aswell as the position of the hip prosthesis can result in a suboptimal outcome for the patient.
This thesis principally examines acetabular component orientation, investigating the use of
technology in this critical aspect of hip arthroplasty surgery.
In the first study, navigation technology is used to assess the performance of a current cohort of
training and senior orthopaedic surgeons in a simulated surgical setting. A wide range of error
in orientating an acetabular cup orientation to a target position is demonstrated. The second
study seeks to establish a novel method of delineating the femoral neck axis in 3D using a
sample of normal hip CT scans. Using such a proximal femoral frame of reference allows a
standardised approach to assessing normal and abnormal hip morphology. The articular margin
of the femoral head is shown to have a wave like pattern that consists of an anterior and
posterior facet. The third study compares 2D and 3D measurements of inclination and version
of acetabular components, finding a critical difference between the two in version
measurements and that 3D measurements are more reliable. The thesis continues by examining
the current methodology of analysing the concentration of cobalt and chromium metal ions in
the joint fluid from a cohort of symptomatic patients with a metal on metal hip arthroplasty. A
more robust laboratory method of processing fluid samples using a digestive oxidative method
is presented. The relationship between concentrations of metal ion levels in joint fluid and
several clinical parameters is investigated with no clear association shown, suggesting joint
fluid in itself cannot be used as a marker for a failing metal on metal hip. The thesis concludes
by comparing navigation technology to conventional ‘freehand’ method in orientating an
acetabular component in a group of patients undergoing metal on metal hip resurfacing. The
results suggest that navigation technology may substantially improve surgeon error in this task.
Technology and three dimensional imaging can play a vital role in improving the accuracy of
orientating an acetabular component in hip surgery. It can be employed in the pre-operative
stages to assess trainee performance, intra-operatively to reduce surgical error and post
operatively to investigate surgeon accuracy on CT imaging.
Version
Open Access
Date Issued
2015-07
Date Awarded
2016-01
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Cobb, Justin
Hart, Alister
Sponsor
Arthur M. Sackler Foundation
Publisher Department
Department of Surgery and Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)